Key result
Diastolic pulmonary gradient better distinguishes combined from isolated post-capillary PH in left heart disease.
Why the study?
The term out-of-proportion pulmonary hypertension in left heart diseases lacked a clear definition and created confusion, and no validated treatment exists for this condition.
This paper proposes replacing the ambiguous term 'out-of-proportion' PH with a hemodynamic distinction between isolated post-capillary PH and post-capillary PH with a pre-capillary component based on the diastolic pulmonary artery-to-wedge pressure difference, while reviewing clinical trials and management strategies.
May refine PH-LHD phenotyping in practice; leaves open prospective validation of the proposed definition.
Pulmonary hypertension (PH), a common complication of left heart diseases (LHD), negatively impacts symptoms, exercise capacity, and outcome. Although the true prevalence of PH-LHD is unknown, a subset of patients might present significant PH that cannot be explained by a passive increase in left-sided filling pressures. The term "out-of-proportion" PH has been used to identify that population without a clear definition, which has been found less than ideal and created confusion. We propose a change in terminology and a new definition of PH due to LHD. We suggest to abandon "out-of-proportion" PH and to distinguish "isolated post-capillary PH" from "post-capillary PH with a pre-capillary component" on the basis of the pressure difference between diastolic pulmonary artery pressure and pulmonary artery wedge pressure. Although there is no validated treatment for PH-LHD, we provide insights into management and discuss completed and randomized trials in this condition. Finally, we provide recommendations for future clinical trials to establish safety and efficacy of novel compounds to target this area of unmet medical need.
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Vachiéry et al. (2013) conducted a review in Pulmonary hypertension due to left heart diseases (PH-LHD). Distinguishing isolated post-capillary PH from combined post- and pre-capillary PH using the diastolic pulmonary gradient is proposed to replace the term 'out-of-proportion' PH in left heart disease.
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